Hello friends. I have not been active on social media for a while because, quite frankly, I have been disappointed by a continued lack of enthusiasm regarding the role of estrogen therapy in menopause management. However, you may be noticing that lately there has been an upsurge in the media regarding topics dealing with menopause. This reinvigorates me because along with this has been a movement on Capitol Hill to push for legislation that would put $275 million towards research and education around menopause.
So, I am dusting off my keyboard and will provide some new posts. For this initial post I will summarize some of the recent news.
Halle Berry announces she is in menopause!
Halle is one of several celebrities making the statement that women in menopause are vibrant, productive members of society and that attitudes need to change. Click here to watch Halle joined by a group of bipartisan senators on Capitol Hill, including Patty Murray from my home state of Washington, advocate for more menopause awareness.
Halle also appeared with Jill Biden in Chicago for a news story about the need for more menopause research. In this clip, some of the groundbreaking work being done on menopause and the brain were presented by noted experts in menopause.
The National Institute of Health plans to study menopause
The NIH Office of Disease Prevention (ODP) is planning a Pathways to Prevention (P2P) workshop to identify research gaps in menopause management. The ODP is partnering with the Office of Research for Women’s Health and multiple other organizations to begin the process of selecting research directions. This effort is outlined in the NIH publication entitled Research on menopause and midlife health.
The WHI study continues to mislead women regarding WHO should take 
HRT and for HOW LONG
Since 2003 the guidelines for using HRT have been based on the WHI study, which basically led to recommendations that HRT should be used only in the lowest doses for the shortest period of time to control severe symptoms. (See my article on the WHI and its impact). Since then, however, the major menopause societies have liberalized their recommendations and note that for most newly menopausal women the benefits outweigh the risks and treatment should be individualized based on patient preferences and goals. Despite this, when you read the most recent summary regarding the WHI, the writers involved in the original study continue to downplay the role of estrogen by using the following wording: the WHI randomized clinical trials do not support menopausal hormone therapy to prevent cardiovascular disease or other chronic diseases. Menopausal hormone therapy is appropriate to treat bothersome vasomotor symptoms among women in early menopause, without contraindications, who are interested in taking hormone therapy. This recent article still refuses to clarify that the findings of the study should only apply to older women who begin treatment many years after their menopause since relatively few women younger than age 55 were in the study. Not surprisingly a number of lay articles have appeared that alert women to the shortcomings of the WHI – such as this one in the New York Times entitled: Women Have Been Misled about Menopause.
The other roadblock women are encountering is that their doctors, again being influenced by the WHI, insist that women go off their hormones after a few years, and generally discourage them from taking them past 60 or 65. However, the Menopause Society in its latest guidelines acknowledges that the time limit for discontinuation is arbitrary.
It was very rewarding to read a recent large scale study using Medicare data that further supported the issue of allowing women to continue long term HRT. Based on the results of this study of over one million women, the researchers concluded that women who were taking estrogen after the age of 65 had a lower risk of death overall compared to women who were not on estrogen. They found significant risk reductions in breast cancer, lung cancer, colorectal cancer, congestive heart failure, venous thromboembolism, atrial fibrillation, acute myocardial infarction, and dementia in women on estrogen alone. Women who took a progestin along with the estrogen had lower medical risks of endometrial cancer, ovarian cancer, ischemic heart disease, congestive heart failure, and venous thromboembolism. The only negative finding was that women taking a progestogen with their estrogen had a slightly higher risk of breast cancer. But of note, they did not have a higher risk of dying from it. And the other point to know is that most of these women were taking a synthetic progestogen, not natural progesterone. As noted in previous blogs, current studies strongly suggest that bioidentical forms of HRT are safer and carry less risk of breast cancer and blood clots.
In summary
It looks like menopause awareness may be coming out of the closet and hopefully we will be seeing more attention paid to the needs of menopausal women. I will be following the progress of the NIH initiative and will be advocating for a study looking at the benefits and risks of HRT in newly menopausal women using the bioidentical hormones we recommend today. I am hoping that at some point we have data to confirm that treatment with natural estradiol is a safe, effective and economical way to preserve women’s health and well-being through the menopause transition and beyond.
Thumbs up! It made sense to me 20 years ago and I’m still seeing the benefits of following your recommendations. So pleased you’ve resurfaced.
Hi Faye. How nice to “hear” from you. Thank you for your support and I will try to keep fighting! Sandy
I was delighted to see a new post from you, Dr. Rice! Your writing and advice are what sent me to a menopause specialist (OB/GYN) who has supported my continued use of bioidentical hormones. I am now 69, turning 70 later this year, and have been on continuous estrogen patch and oral progesterone for close to 15 years. The observational study you link in your post is what many of us have been waiting for. It would be great if NIH would sponsor a study of us long-timers. I’m sure I’m not alone!
I did have one question. I read the study carefully and it appears, unexpectedly, that estrogen plus a synthetic progestin is actually more protective than estrogen plus progesterone, at least for several different potential cardiovascular averse outcomes. Do you have thoughts on this? Pertinent quote :”When used alone, progesterone was associated with significantly decreased risks of three CV conditions (CHF, VTE, and AMI), whereas progestin exhibited no risk reductions at all. However, when combined with estrogen, E+ progestin did exhibit significant risk reductions in IHD, CHF, and VTE, whereas E+ progesterone exhibited risk reduction for CHF alone.”
Wow Dee. I am impressed that you read the article so thoroughly. It is very detailed. I agree that it doesn’t make sense that any of the risks would be higher with a progestin than progesterone when combined with estrogen. In looking at the categories, it looks like the risks for DVT may have accounted for a lot of the more negative results, but then this doesn’t make sense either. There were twice as many women on progestins as on progesterone so this may have had a bearing.
Regarding your other observation, it makes sense that progesterone alone would have more benefit than a progestin alone. I wonder why these women were only on a progestogen. It is possible they were on something else like an estrogen preparation that wasn’t covered by Medicare, which may not have shown up in the data base. These are all issues that make these types of observational studies less robust since there are a lot of unknown confounding variables. But the fact that the study was so big and showed that overall mortality was decreased in both the women on estrogen plus progestin and estrogen plus progesterone, the study is very telling. And since cardiovascular disease represents the highest risk of death for women, I think that taking HRT has an overall benefit in reducing cardiovascular deaths regardless of the minor variations in the subgroups. I suspect there are going to be a lot of editorial comments in the medical literature addressing questions like yours so I will be interested in seeing those. Sandra
Thank you for pursuing this important topic in women’s health. The use of hormones was so downplayed in my time that I feel I may have missed benefits that they may have provided then as well as subsequently.
I read the Howard Hodis study a couple of years ago, which corroborates much (or all) of the information you’ve been bravely presenting regarding the statistical benefits of HRT.
I hope this is the final swing of the pendulum.
Hi Lael, how nice to “hear” from you. I wish we were approaching the final swing of the pendulum but I think there are many naysayers in the academic world who stubbornly insist on randomized controlled studies to make the guidelines. And to get a big study it will cost a lot of money (and I don’t see the pharmaceutical companies getting on board since estrogen is generic) plus its hard to envision enough women to enroll, because they may not want to be on a placebo if they are having hot flashes and they may not want to take estrogen if they are convinced it will give them breast cancer! Sandy
Dear Dr. Rice,
I am so glad that you are back on the scene! I have your site and book featured in my recommended sources when I present on singing voice and menopause. I am happy to share your past and future thorough, thoughtful overviews of information that women need to have. And now I must read more on the Medicare study on women who continue on estrogen later in life. (That’s me!)
Thank you and onward!
Joanne
Hi Joanne, thank you for your continued support. I have referred people to your book as well and think about you when I see a performer who I think is postmenopausal and wonder if she has been on HRT to preserve her vocal skills! I think I will write a blog on the Medicare study to summarize it. It is very detailed and I suspect there may be some back and forth in the medical literature discussing it. So I will be interested in seeing what ensues over the next several months and share all that information.
Thanks for your reply, Dr. Rice. I, along with others, I’m sure, would appreciate a breakdown of the Medicare study – when appropriate. I so appreciate your continued recommendation of our book (for the curious: “Singing Through Change: Women’s Voices in Midlife, Menopause, and Beyond”)! Looking forward to more helpful information from you in the future.
All best,
Joanne